VICTOR USMAN
Subscriber on policy B02M000642
Claims
3
Attributed to this person
Charged
1,602.00
Total submitted
Denied
737.00
2 denied claims
Patient responsibility
251.55
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | VICTOR USMAN |
| Role on the policy | Subscriber |
| Policy | B02M000642 |
| Date of birth | 21 Jun 2001 |
| Plan | SILVER HMO |
| Covered from | 21 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 251.55 |
| Total | 251.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002702 | 30 Jul 2026 | 387.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002703 | 10 Oct 2024 | 478.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002701 | 9 Aug 2024 | 737.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 737.00 |